Evidence-based antenatal interventions to reduce the incidence of small vulnerable newborns and their associated poor outcomes

G Justus Hofmeyr; Robert E Black; Ewelina Rogozińska; Austin Heuer; Neff Walker; Per Ashorn; Ulla Ashorn; Nita Bhandari; Zulfiqar A Bhutta; Annariina Koivu; Somesh Kumar; Joy E Lawn; Stephen Munjanja; Pieta Näsänen-Gilmore; Doreen Ramogola-Masire; Marleen Temmerman; Lancet Small Vulnerable Newborn Steering Committee

doi:10.1016/S0140-6736(23)00355-0

Evidence-based antenatal interventions to reduce the incidence of small vulnerable newborns and their associated poor outcomes

Lancet. 2023 May 20;401(10389):1733-1744. doi: 10.1016/S0140-6736(23)00355-0. Epub 2023 May 8.

Authors

G Justus Hofmeyr¹, Robert E Black², Ewelina Rogozińska³, Austin Heuer⁴, Neff Walker⁴, Per Ashorn⁵, Ulla Ashorn⁶, Nita Bhandari⁷, Zulfiqar A Bhutta⁸, Annariina Koivu⁶, Somesh Kumar⁹, Joy E Lawn¹⁰, Stephen Munjanja¹¹, Pieta Näsänen-Gilmore⁶, Doreen Ramogola-Masire¹², Marleen Temmerman¹³; Lancet Small Vulnerable Newborn Steering Committee

Collaborators

Lancet Small Vulnerable Newborn Steering Committee:
Per Ashorn, Robert E Black, Joy E Lawn, Ulla Ashorn, Nigel Klein, G Justus Hofmeyr, Marleen Temmerman, Sufia Askari

Affiliations

¹ Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Obstetrics and Gynaecology, Walter Sisulu University, East London, South Africa.
² Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: [email protected].
³ Evidence-Based Medicine Consultancy, Bath, UK.
⁴ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
⁶ Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
⁷ Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
⁸ Centre of Excellence in Women and Child Health & Institute for Global Health & Development, Aga Khan University, Karachi, Pakistan; Centre for Child Global Health, Hospital for Sick Children, Toronto, ON, Canada.
⁹ Jhpiego, Baltimore, MD, USA.
¹⁰ MARCH Center, London School of Hygiene & Tropical Medicine, London, UK.
¹¹ Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe.
¹² Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana.
¹³ Centre of Excellence in Women and Child Health-East Africa, Aga Khan University, Nairobi, Kenya.

PMID: 37167988
DOI: 10.1016/S0140-6736(23)00355-0

Abstract

A package of care for all pregnant women within eight scheduled antenatal care contacts is recommended by WHO. Some interventions for reducing and managing the outcomes for small vulnerable newborns (SVNs) exist within the WHO package and need to be more fully implemented, but additional effective measures are needed. We summarise evidence-based antenatal and intrapartum interventions (up to and including clamping the umbilical cord) to prevent vulnerable births or improve outcomes, informed by systematic reviews. We estimate, using the Lives Saved Tool, that eight proven preventive interventions (multiple micronutrient supplementation, balanced protein and energy supplementation, low-dose aspirin, progesterone provided vaginally, education for smoking cessation, malaria prevention, treatment of asymptomatic bacteriuria, and treatment of syphilis), if fully implemented in 81 low-income and middle-income countries, could prevent 5·202 million SVN births (sensitivity bounds 2·398-7·903) and 0·566 million stillbirths (0·208-0·754) per year. These interventions, along with two that can reduce the complications of preterm (<37 weeks' gestation) births (antenatal corticosteroids and delayed cord clamping), could avert 0·476 million neonatal deaths (0·181-0·676) per year. If further research substantiates the preventive effect of three additional interventions (supplementation with omega-3 fatty acids, calcium, and zinc) on SVN births, about 8·369 million SVN births (2·398-13·857) and 0·652 million neonatal deaths (0·181-0·917) could be avoided per year. Scaling up the eight proven interventions and two intrapartum interventions would cost about US$1·1 billion in 2030 and the potential interventions would cost an additional $3·0 billion. Implementation of antenatal care recommendations is urgent and should include all interventions that have proven effects on SVN babies, within the context of access to family planning services and addressing social determinants of health. Attaining high effective coverage with these interventions will be necessary to achieve global targets for the reduction of low birthweight births and neonatal mortality, and long-term benefits on growth and human capital.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Female
Humans
Incidence
Infant
Infant, Newborn
Parturition
Perinatal Death*
Pregnancy
Prenatal Care
Stillbirth